Provider Demographics
NPI:1760601504
Name:SILVER, SHANE H (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:H
Last Name:SILVER
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 RIVERSIDE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4123
Mailing Address - Country:US
Mailing Address - Phone:904-634-0805
Mailing Address - Fax:904-634-0950
Practice Address - Street 1:1050 RIVERSIDE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4123
Practice Address - Country:US
Practice Address - Phone:904-634-0805
Practice Address - Fax:904-634-0950
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53943OtherBLUECROSS BLUESHIELD
FL53943Medicare ID - Type Unspecified